SVS Section on Ambulatory Vascular Care (SAVC) set to announce set of new initiatives designed to help office-based lab (OBL) vascular surgeons combat rising costs and stagnant payments during jam-packed session focused on the outpatient setting at the 2025 Vascular Annual Meeting (VAM) in New Orleans (June 4–7).
The way Anil Hingorani, MD, sees it, vascular surgeons operating in the OBL outpatient setting are feeling the pinch amid an unforgiving economic climate. With the omnipresent threat of Medicare cuts, stagnant or decreasing payments, and escalating inflationary pressure, they are hurting, the SAVC chair explains. Many private-practice specialists behind OBLs are choosing to shutter their practices. Others with the means are converting their facilities into the OBL’s outpatient cousin, ambulatory surgery centers (ASCs). For many vascular surgeons in this OBL, the personal costs run high, Hingorani, a vascular surgeon in Brooklyn, New York, details. “This is putting a lot of stress on private practitioners who have invested very heavily in OBLs—personal investment quite a bit of the time—and they are often personally liable,” he says.
So, the SVS and its section dedicated to the issues facing outpatient practices are taking action through a series of new initiatives aimed at helping OBLs cut costs. The exact details of the SVS plans are set to unveiled toward the end of the pair of back-to-back SAVC sessions taking place at VAM 2025 on Friday, June 6 (2–5 p.m.) in the Morial Convention Center host venue (Second Floor, Room 224).
“Without revealing too much ahead of time, these SVS initiatives are about cost-savings for OBLs amid the cuts, and I think these will be especially important for the smaller practices, because those are the ones that are being hurt the most,” says Hingorani, who will be one of the moderators of the SAVC sessions. “They are the ones that I think we can help the most. We’ve done some preliminary work on this already, and I would say is going to be a key component, for one-, two- or three-practitioner practices. And, these don’t have to be just vascular-surgeon-only practices; they can be multispecialty groups as well.”
The economic headwinds impacting on OBL surgeons and driving the SVS and SAVC to action are stark, Hingorani explains. “Some of the transition going on is being dictated by CMS [the Centers for Medicare & Medicaid Services]. Some of it is because the RVU [relative value unit] conversion rate has not increased for 30 years, and inflation has clearly been going up over the last couple of years,” he continues. “So, if you’re in the OBL, you’re getting it from both ends. If your costs are increasing and your payments are the same—or decreased in some parts of the OBL—that’s a squeeze financially. That’s one of the reasons why these OBLs are being converted into ASCs. That also takes considerable investment. A lot of reasons why places open as OBLs is that ASCs are expensive, have much higher regulation and require a lot more investment, so it is a higher-stakes game to convert a pre-existing OBL to an ASC. Hopefully some of these new SVS initiatives will make a significant impact.”
The SAVC sessions at VAM 2025 feature the spectrum of issues related to practice in OBLs and ASCs.
Highlights include a couple of talks that focus on artificial intelligence (AI) use in ambulatory centers. Uwe Fischer, MD, an assistant professor of surgery at Yale School of Medicine in New Haven, Connecticut, is bringing expertise on AI’s use to improve vascular diagnostics and treatment outcomes, while Alisha Oropallo, MD, a professor of surgery at Hofstra University/Northwell in Lake Success, New York, will offer insight on how AI chatbots might improve chronic vascular wound management outcomes in OBLs and ASCs. Much of the work presented comes from SAVC research and seed grants, and recaps prior years as well as points ahead to new work coming up. Meanwhile, the annual Excellence in Community Practice Awards will again take place toward the end of the SAVC program, Hingorani notes.
SAVC’s focus on research in this arena seeks to fill a void, the section chair points out. “The reason why we are trying to open up this space for research is because there really has not been a lot in the OBL or ASC space,” he says. “I think part of that has been financial directives of the field and trying to stay afloat but also support.
“Part of the reason why we have this session is to give a platform for people to present heir work, but also for the seed grants. Specifically, this is to give support to hire statisticians, get a database, or to help input the data, analyze the data, present the data—to help the process of actually getting your research out. If we say that more than 50% of lower extremity angioplasties are performed in the outpatient space, where are the data? We have the numbers. But where are the results, what are the challenges, what are the opportunities, what are the changes that take place when you start doing these procedures as an inpatient and then transfer them to an outpatient?”
